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HIV/AIDS: Physicians Seek Higher Reimbursement Rates

As managed care reimbursement rates put the squeeze on physicians who treat people with HIV/AIDS, the fledgling Florida Academy of HIV Physicians is planning to fight back, the St. Petersburg Times reports. The newly formed group is gearing up to lobby the state Legislature to designate HIV physicians as specialists, a move that would give them more leverage with HMOs when negotiating reimbursement rates. According to Academy Chair Dr. Robert Wallace, a physician who has been providing care for HIV patients in the Tampa Bay area for 15 years, managed care companies reimburse doctors who treat HIV patients at the same rate as primary care doctors. Those reimbursement rates make sense for doctors who have a large patient base and see those patients once or twice a year, as is the case of most primary care physicians, Wallace said. But HIV patients require continuous care and frequent exams, leaving the physicians who treat them will less time to see as many patients. Several area AIDS treatment centers have been forced to close. The Center for Quality Care shut its doors in December, leaving nearly 1,200 HIV/AIDS patients scrambling to find new providers, and, Wallace, who treats about 400 patients, is closing his practice at the end of the month. Dr. Michael Dunn, who opened his own practice after the Quality Care center closed, said, "A lot of times, managed care (companies) just want to lump it into internal medicine. It's a lot more work and a lot more paperwork than a little old lady with high blood pressure and diabetes." However, some insurers indicated that they were responding to the problem. Blue Cross and Blue Shield of Florida has set up a special "above market value" fee schedule that pays physicians who treat HIV patients by the visit, not by the patient. Still, some fear that the patients "could be left without adequate care" as physicians leave the field. The recently formed American Academy of HIV Physicians also has joined the effort, with plans to lobby for changes on a nation level, while the American Medical Association is studying repayment rates for various specialties (Allison, St. Petersburg Times, 3/14).

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